Provider Demographics
NPI:1154779601
Name:MOFFO, JENNA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:MOFFO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:COST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3430 BURNET AVE # 4007
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-2833
Mailing Address - Country:US
Mailing Address - Phone:138-035-5375
Mailing Address - Fax:
Practice Address - Street 1:2161 BOLSER DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-3933
Practice Address - Country:US
Practice Address - Phone:513-755-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2187155Medicaid